Gottlieb and Astrue: ObamaCare's Technology Mess

President Obama is bracing Americans for inevitable problems as the Affordable Care Act rolls out this week, but what he calls "glitches" are hardly routine. Information technology is ObamaCare's Achilles' heel. The faulty IT will expose Americans to lost data, attempts to enroll online that fail and the risk of fraud.

There are two key technological flaws in ObamaCare. First is the "hub"—the software to link servers at the Treasury Department, the Internal Revenue Service, Homeland Security and state agencies to verify the income and health-insurance status of enrollees and ensure that they are eligible for subsidies. The other flaw is the "portal"—the federally run IT platform that is supposed to let consumers compare health plans and select one that best suits their needs.

In planning ObamaCare's IT infrastructure, the Centers for Medicare and Medicaid Services (CMS) dawdled for more than a year under Administrator Donald Berwick until Marilyn Tavenner took over in December 2011. Even then the agency was slow to outsource key contracts and turned to what insiders say were not top-quality programmers. CMS did not sign a contract for a backstop system to process paper verifications and do paper verifications of online applications until July.

The Health and Human Services Department did not begin testing the chief pieces of this IT system until August. The testing found that states couldn't consistently link to the federal portal (a problem that persists in some states), and that the hub couldn't reliably verify if a person is eligible for a subsidy, or accurately calculate how much the applicant is eligible to receive. HHS prevented independent watchdogs, including its own inspector general, from examining the systems before they go live on Oct. 1. The result is a host of troublesome gaps and dangers.

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The biggest risk involves data security. The Obama administration created unnecessary opportunities for fraud with the White House's pork-minded insistence on funding favored community groups to employ "navigators" to solicit applicants and help them input their personal information, such as income and Social Security numbers. The navigators were hastily hired and trained (they are still being hired) and were not given extensive background checks. The personal data for millions of people will be entrusted to these navigators—and to a computerized system that has been rushed into operation.

Another technological hurdle involves health-insurance subsidies. At least a half-dozen states, including Colorado and Oregon, have said that they won't offer full online enrollment through their exchanges because the federal hub that is supposed to link to help them determine the subsidies people are eligible for isn't working properly. A link to Medicaid agencies also isn't functioning. This link is necessary to ensure that someone applying for a subsidy under a health plan is not Medicaid-eligible under his state's rules.

If the hub can't verify this, the individual will get booted from the ObamaCare enrollment system and shifted to a call center for confirmation by an ObamaCare agent who is likely to be fielding a deluge of complaints. Some people will end up getting subsidies they weren't qualified for. Washington eventually will have to try to claw back the money. This will create a massive pay-and-chase challenge as people move in and out of the exchanges and get subsidies that many of them won't even know they didn't deserve.

The subsidies will likely present other woes. For example, separate cost-sharing subsidies intended to reduce a person's out-of pocket costs are subject to the budget sequester. As a result, some of the reductions in co-insurance won't materialize. Patients won't know what they will owe for doctor visits, prescriptions or hospital stays. The Obama administration hasn't begun to address the issue.

As for medical care, the current ObamaCare software doesn't even try to take a serious stab at letting consumers match the health plans on the exchanges with their particular medical needs, or with their providers, at the point of enrollment. In some cases—but not necessarily all—they can click through to the plans to ferret out the information they need.

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On Friday, HHS finally awarded a $380 million, four-year contract to manage appeals from consumers fighting for benefits that the insurance plans have denied. If it was hard to appeal medical claims through your current insurance plan, wait until you have to call a remote federal contractor.

The technology and privacy problems presented by ObamaCare aren't likely to be mere rough patches that can be easily smoothed over. The provision of health care is an inherently local endeavor, and it increasingly appears that so is applying for health insurance. ObamaCare is an attempt to federalize the entire system, but the IT backbone appears unable to support this political ambition.

In September, the Minnesota state health-insurance exchange inadvertently disclosed several thousand Social Security numbers before the exchange even opened for business. Once the entire, gargantuan system is fired up nationwide, data leaks are almost a certainty.

That's the thing about technology: Glitches happen. Usually they're annoyances. Now, more than ever, they're going to involve the government and your health.

Dr. Gottlieb is a physician and resident fellow at the American Enterprise Institute. He is the Republican appointee on the HHS Federal Health IT Policy Committee that works on electronic health record guidelines for doctors' offices but has nothing to do with the rollout of the ObamaCare exchanges. Mr. Astrue was the Commissioner of Social Security until earlier this year.

Certainly not anyone whose IQ is higher than their shoe size, except for the lefties who'll believe anything that the Obamaminable One and his acolytes tell them with plenty of help from Sawyer, Pelley & Williams.

Management incompetence is Mr. Obama's hallmark, not surprising for a man with no management experience suddenly vaulted to the top of a huge government. Still, he has had four years of on-the-job training, but he evidently has not learned much. He is beginning to make more Americans long for a Republican Administration.

Would love to hear someone actually point out SPECIFICALLY what they don't like about the ACA instead of just jumping on the bandwagon. I find that most people have no idea what it's about at all. There is a learning curve for everything, especially something as major as healthcare for an entire nation. Of the people who are complaining before they've experienced anything negative, I have to believe it's just the ongoing hatred for all things Obama and not because they actually know what they're talking about. People, you have to move on...the dude is in his second term already! Are you all too stupid to know that it's the Republicans that are holding you hostage and not the President? How can anyone be against spreading the cost of healthcare to people who need it and many of whom had not been paying for it at all? Jeez...

These people shouldn't be called navigators, but opportunists that can rob people of their precious identities. Giving these contracts to groups like Acorn is something a political hack like the former Acorn " Community organizer" would be expected to do. Corruption at the highest levels with people's potential stolen identities at stake. Wonderful !

I can't wait until Obama disowns ObamaCare in a moment of frustration by saying, "I didn't write it. I wanted single pay." and he resents that his name is on it. "It was really Nancy's folks who created this mess." I know he's going to say it to his closest friends, so please let someone hear who will tell us!

ObamaCare Navigators - such an amusing term. The implication is no one can steer through these murky and treacherous waters. At best these community organizing navigators will be the blind leading the blind, but in many cases it will be like handing your wallet to a backstreet thug. Good luck to all those unfortunate enough requiring these "services" sent directly from the liberal messiah himself.

"The internal effects of a mutable policy are still more calamitous. It poisons the blessing of liberty itself. It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man, who knows what the law is to-day, can guess what it will be to-morrow. Law is defined to be a rule of action; but how can that be a rule, which is little known, and less fixed?" - James Madison, "The Federalist #62"

Many people are excusing the Gov't today for 'glitches' in the system. There is no glitches - it is not working period! I have been on the early end of many new technologies and they all had little issues but they at least worked! If someone is trying to sell you a car and it won't start do you just mark it up to a glitch? A glitch is the turn signal failing one time.I also like the other reason; it has been so successful with over a million hits. Any experienced program manager would have built this to handle the load or if unable, implemented it in stages to limit access.This is a bad IT job that was given four years to prep/plan/test.

Wait a minute.......Heath care will fail because bloated unionized progressive voting pool like the DMV? So how people vote on any other issues will cause this to fail? ..... I think it will fail becuase of over crowded class rooms.. .Make about the same amount of sense. Besides,,,, since when are state employees of the DMV unionized?

Just tried to use it here in Florida. Got to the point where it asked me to provide 3 answers to security quesitons for future visits, but the security questions are blank. It wont let you continue without answering. So I picked three answers and put them in blank spots...dog, cat, parrot...it said that no two answers can be the same. I'm quite sure a dog and a cat are different. Oh well.

My wife went to the post office on her lunch break to get a passport photo, that they had recently started offering. She paid in advance. After waiting a very long time she asked when she'd finally get the photos. They didn't know as the only person who knew how to operate the new camera had decided to go to lunch after taking my wife's picture. My wife had to leave and asked for her money back. They could not give her her money back without her filling out a form in triplicate and submitting it to the Federal Postal authorities. She gave up and "contributed" the fee to the Postal Service. .I'm sure Obama care will be very different.

This article and the personal anecdotes that are being expressed today remind me of the furor that accompanies every launch of a major new version of Windows. Same forecasts of doom, same angry denunciations because someone was inconvenienced for a hour or two, same promises of revenge, of punishing either Microsoft or the government.

And yet, everything got fixed, everyone was served, everything ended up working just fine. What the complainers forget is that products and services evolve. The state and federal operatives who designed and built the heath-exchanges want flawless processes just as much as the programmers at Microsoft. Just because they work for the government doesn't mean they don't give a hoot, and the Microsoft-bashers would rant about arrogant and incompetent Microsoft engineers with the same overwrought venom as community members are now doing about federal employees.

But the ACA will issue service pack 1 and then service pack 2, and within a year or so the system will work as flawlessly for most users as Windows 8 does now. And in ten years time all this kerfuffle will be forgotten and the pain and injustice of our formerly broken health-care will be a thing of the past.

So everyone MUST have health insurance coverage or they get fined.... oops, I mean taxed. The government is compelling us to provide financial and health care information to a system that is not secure.

I asked a simple question about computers at a hospital one time, "Why don't we have everyone's medical records on file at one hospital be transferable to another one or for various doctors offices.

Because there is no standard on the medical software that hospitals use, the languages of that software, and the various platforms being used. Not everyone is using windows 8 let along windows 7, some machines are quite older and can't even talk to the internet. Some Hospitals can't even use thumb drives on their computers because most of them are 'Dumb' terminals that go to a mainframe in the basement.

Proprietary software, the upgrades that do not communicate to the outside world are some hospitals mainstays...

IT would cost Billions maybe Trillions to put them all on one system, that can communicate with each other.

And that would drive up healthcare costs...

When has any Government system ever stayed within budget? Ever?

Welcome to your new Health System...it is going to be FUBAR...from the very start...

In the Bluest most orgasmically pro-Obama state in the nation the website works...as of now....

However, as of now, there are zero plans with rates or benefits approved for sale by either of California's two state insurance regulatory bureaucracies -- the Department of Managed Health Care (DMHC) or the Department of Insurance (DOI). Even if there were plans available, there's no one to sell them because there are zero licensed and certifiedagents contracted with CoveredCA.

(...I guess they had no time to get ready....the past 3+ years snuck up on the bureaucrats....)

Nice to see the government is living up to the carefully crafted reputation it has honed over many decades. That's what happens when you leave the details of an important aspect of your life to a bunch of fuzzy-headed politico hand-waivers.

"Close enough for government work" now hits you more than ever - in the personal healthcare and pocketbook.

Well, since you decided to make a fool out of yourself and ask; I tried to register for the fed exchange just out of curiosity. The first try failed - I never received the email confirmation and when I tried to get another one sent, it had no record of my registration. Second time I disappeared again, but the third time I got the email only to not be allowed to log-in. I have since given up, but my ultra-liberal doctor recently informed me that he has stopped taking new patients altogether and is not seeing many of his current patients anymore, mainly due to the inordinate amount of time he and his staff now have to spend on the Obamacare-mandated electronic health records. Mind you, the man was all for Obamacare when it first came out because we needed to "expand healthcare to everyone in the nation", more in the interest of his pocketbook than altruism I suspect. Today, Medicare/Medicaid patients that have not been seeing him for over a decade are no longer accepted, and even people with private insurance are being turned away. If that weren't enough, my employer has gotten rid of my healthcare and my individual rates just took a 45% jump. Thank God I still am lucky enough to work full time though - my 45 hr weeks are a Godsend when hundreds of thousands, perhaps millions, have seen their hours cut to 29 or their jobs gone altogether.

So before you assume that this is all just Right-wing fearmongering and hatred, understand that this has a real effect on real people. Everything that we have said for the last 3 years has come true, and many of the problems have affected me personally. Even still, I count myself as one of the lucky ones (although not lucky enough to be an Obama crony or "favored group" who've been exempted from Obamacare) for still having a steady, full time job. How good is "spreading the cost of healthcare to people who need it" a good thing when it puts the very people who are paying for the healthcare of those who can't or WON'T work out of a job? Who is going to pay for all of this madness when millions more people are out of a job or working part time? Where is the money going to come from to gift health insurance to those who work for it when the economy continues to putter along under the weight of Obama's regulatory nightmare?

This isn't hatred for Obama, and before you criticize the Right for continuing to oppose a President whose policies are the direct, proximate cause of the economic stagnation, increasing energy costs, skyrocketing healthcare costs, continued high unemployment, division, and absolutely disastrous foreign affairs just because it's his second term, remember what the Left did to Bush in his second term. According to you & your people, Bush was a fascist, the worst man ever to live. The man couldn't cough without the pitiful Left attacking. I certainly don't hate Obama, but I despise his policies and Progressivism.

But then again, what else should we expect from the Left - delusional hypocrites one and all.

You will have coverage from a private company, care from a private provider, and in other respects the only changes are access to coverage and getting everyone to have coverage.

The story of what your wife experienced sounds hard to believe. Since when does the post office take passport photos? Who would not get it done at Kinko's or Walgreen's or elsewhere and get their photos immediately?

I use the USPS all the time and never have problems like you describe.

Lets not forget that Microsoft had competitive pressures to iron out it's problems, and that we had a choice in whether or not to use it's products. The government has neither, which is why this is going to continue for quite some time. Even when the technological issues are fixed in a decade, the lasting damage from the newest Progressive boondoggle will continue to be felt, just like the War on Poverty, the New Deal, the Great Societies Programs, and every other disaster the Left has foisted upon us.

But in the end it's all worth it in the name (though not results) of ending pain & injustice wherever you can wish it into existence, right? Thank God for the Left's solution for all "injustice" - bring the have's down to the level of the have-not's, because it's only "fair" for the Left to take what one man has earned to give to another man who hasn't so we can all have an equal amount of poverty.

Yes, some of the new versions of Windows worked so well that I bought older versions to retrofit my PC. Then I decided enough Windows problems, hacked computers, etc. and bought an Imac. It took some time to learn the new OS but I have not looked back at Windows. Frankly I think compared to Windows whatever, the ACA software problems are an unending snake pit which will be solved at the government pace not the Microsoft new product pace or intensity..

Poverty? What on earth do you think there was before Social security and Medicare? Have you any idea just how much wealthier most Americans are today than they were before the Great Society programs - do you understand that every society on earth that has introduced social welfare programs has prospered to a greater degree than any other society in any period of history?

Do you know anything at all about the social history of this country and of the countries of Europe where life has been transformed for all three post-war generations by the provision of social welfare programs? Even in the so-called failed Mediterranean countries life today is unimaginably better than it was even fifty years ago. I traveled throughout the Mediterranean in the 1960's and 1970 and I've seen the transformation for myself.

You may wish to go back to world Upton Sinclair so vividly described in the Jungle, but you'll lead a lonely crusade. Even the blue-collar guys who call Rush Limbaugh to fawn and grovel around about wanting more tax cuts for the wealthy won't be marching with you to tear down Social Security and Medicare. And in ten years time they'll be just as passionate supporters of the Affordable Care Act.

Remember the crackpot at the Tea Party meetings with the "Keep the Government out of my Medicare" banner. That's your fellow Tea Party supporter.

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